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Anesth Analg 1986; 65:625-632
© 1986 International Anesthesia Research Society
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Bupivacaine for Intercostal Nerve Blocks in Children

Blood Concentrations and Pharmacokinetics

Peter Rothstein, MD, G. Richard Arthur, PhD, Hal S. Feldman, BSc, Gary S. Kopf, MD, and Benjamin G. Covino, PhD, MD

Received from the Departments of Anesthesiology, Pediatrics, and Surgery, Yale University School of Medicine, the Pediatric Intensive Care Unit, Yale-New Haven Hospital, New Haven, Connecticut, and the Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

A pharmacokinetic evaluation of bupivacaine was carried out after intercostal nerve blocks performed on 28 occasions in 27 children varying in age from 3 months to 16 yr. Bupivacaine HCl, 0.5%, with epinephrine 1: 200,000 was employed. Doses of 2 mg/kg, 3 mg/kg, and 4 mg/kg resulted in peak whole blood arterial bupivacaine (base) concentrations (mean ± SD) of 0.77 ± 0.25 µg/ml, 1.37 ± 0.23 µg/ml, and 1.87 ± 0.53 µg/ml, respectively. Calculated pharmacokinetic parameters (mean ± SD) were the following: apparent volume of distribution (VDß), 2.8 ± 0.8 L/kg; steady-state volume of distribution (VDss), 2.7 ± 0.7 L/kg; elimination half-life (t1/2ß), 147 ± 80 min; and total body clearance (Cl), 16.0 ± 7.4 ml·min–1·kg–1 or 382 ± 201 ml·min–1·m–2. Compared with data reported for adult patients, our data indicate that the volume of distribution is greater and clearance is more rapid in children than in adults. The absorption of local anesthetic from the intercostal space appears to be more rapid in children than adults. In an additional group of 11 children, the relationship of the bupivacaine blood: plasma concentration ratio ({gamma}) to hema-tocrit was investigated. Hematocrit in this group ranged from 30 to 59, and {gamma} varied from 0.47 to 0.82. There was a significant relationship between {gamma} and hematocrit defined by the equation {gamma} = –0.0079 Hct + 1.028 (r = 0.72, P < 0.05). Reporting bupivacaine concentration in terms of plasma concentration may introduce an artifact that is dependent on the hematocrit, and we therefore suggest that whole blood concentration values be reported by investigators in the future.

Key Words: ANESTHETICS, LOCAL—bupivacaine • ANESTHESIA—pediatric • ANESTHETIC TECHNIQUES, REGIONAL—intercostal block






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1986 by the International Anesthesia Research Society.